Healthcare Provider Details

I. General information

NPI: 1033737739
Provider Name (Legal Business Name): ALAN HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15150 W SUNSET BLVD
PACIFIC PALISADES CA
90272-3720
US

IV. Provider business mailing address

3873 BAYSIDE ST
SIMI VALLEY CA
93063-2822
US

V. Phone/Fax

Practice location:
  • Phone: 310-454-1345
  • Fax:
Mailing address:
  • Phone: 805-813-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: